Use of vaginal dilators and effects on vaginal volume and quality of life: a randomized clinical trial
DOI:
https://doi.org/10.1590/Keywords:
Brachytherapy, Cervix Cancer, Vaginal Stenosis, Sexual Health, Treatment AdherenceAbstract
Although it is advised to use vaginal
dilators following radiotherapy to prevent vaginal
stenosis, compliance is frequently low. This study aimed
to assess adherence to the use of vaginal dilators after
brachytherapy and its effects in women who received
phone call or texting apps guidance. A total of 30 women
who previously underwent brachytherapy for cervical
cancer were randomized into two groups using the R
program: monitoring via phone calls and monitoring via
text messages. They underwent gynecological examination
with measurement of vaginal volume and answered the
Functional Assessment of Cancer Therapy-Cervix Cancer
(FACT-CX) questionnaire at the initial consultation and
at the sixth month. No association was found between
adherence and the types of follow-up (p=0.79). In the
first month, 43.3% adhered to dilators, 36.6% did so in
the third month, and 23% in the sixth month. The highest
adherence group had higher difference in vaginal volume scores (16.81±10.45 cm3) compared to the nonadherence group
(10.45±9.55 cm3) with a strong effect size (d=1.68). The difference
between the initial and final vaginal volume was not associated
with the FACT-CX scores (rho=−0.369; p=0.08. Although no
differences were observed in adherence to dilators and type
of follow-up, high adherence demonstrated a direct effect
on increasing vaginal volume, showing the need to promote
educational forms that encourage adherence.
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References
Wang K, Tepper JE. Radiation therapy-associated toxicity:
Etiology, management, and prevention. CA Cancer J Clin.
;71(5):437-54. doi: 10.3322/caac.21689
Akbaba S, Oelmann-Avendano JT, Krug D, Arians N, Bostel
T, et al. The impact of vaginal dilator use on vaginal stenosis
and sexual quality of life in women treated with adjuvant
radiotherapy for endometrial cancer. Strahlenther Onkol.
;195(10):902-12. doi: 10.1007/s00066-019-01466-1
Bergin R, Hocking A, Robinson T, Kabel D, Mileshkin L, et al.
Continuing variation and barriers to nurse-led vaginal dilator
education for women with gynaecological cancer receiving
radiotherapy. Eur J Oncol Nurs. 2016;24:20-1. doi: 10.1016/j.
ejon.2016.08.001
Morris L, Do V, Chard J, Brand AH. Radiation-induced vaginal
stenosis: current perspectives. Int J Womens Health. 2017;9:273-
doi: 10.2147/IJWH.S106796
Bahng AY, Dagan A, Bruner DW, Lin LL. Determination of
prognostic factors for vaginal mucosal toxicity associated with
intravaginal high-dose rate brachytherapy in patients with
endometrial cancer. Int J Radiat Oncol Biol Phys. 2012;82(2):667-
doi: 10.1016/j.ijrobp.2010.10.071
Damast S, Jeffery DD, Son CH, Hasan Y, Carter J, et al.
Literature review of vaginal stenosis and dilator use in radiation
oncology. Pract Radiat Oncol. 2019;9(6):479-91. doi: 10.1016/j.
prro.2019.07.001
Bakker RM, Mens JWM, de Groot HE, Tuijnman-Raasveld CC,
Braat C, et al. A nurse-led sexual rehabilitation intervention
after radiotherapy for gynecological cancer. Support Care
Cancer. 2017;25(3):729-37. doi: 10.1007/s00520-016-3453-2
Haddad NC, Soares Brollo LC, Pinho Oliveira MA, Bernardo-Filho
M. Diagnostic methods for vaginal stenosis and compliance
to vaginal dilator use: a systematic review. J Sex Med.
;18(3):493-514. doi: 10.1016/j.jsxm.2020.12.013
Dupont WD, Plummer WD Jr. Power and sample size
calculations for studies involving linear regression. Control Clin
Trials. 1998;19(6):589-601. doi: 10.1016/s0197-2456(98)00037-3
Cerentini TM, Schlöttgen J, Viana da Rosa P, La Rosa VL,
Vitale SG, et al. Clinical and psychological outcomes of the
use of vaginal dilators after gynaecological brachytherapy: a
randomized clinical trial. Adv Ther. 2019;36(8):1936-49. doi:
1007/s12325-019-01006-4
Brand AH, Do V, Stenlake A. Can an educational intervention
improve compliance with vaginal dilator use in patients treated
with radiation for a gynecological malignancy? Int J Gynecol
Cancer. 2012;22(5):897-904. doi: 10.1097/IGC.0b013e31824d7243
Haddad NC, Soares LC, Oliveira MAP, Bnardo-Filho M.
Reprodutibilidade técnica do cálculo do volume vaginal - um
estudo piloto. Saúde Desenvolv Hum. 2022;10(2). doi: 10.18316/
sdh.v10i2.7698
Amies Oelschlager AM, Debiec K. Vaginal dilator therapy: a
guide for providers for assessing readiness and supporting
patients through the process successfully. J Pediatr Adolesc
Gynecol. 2019;32(4):354-8. doi: 10.1016/j.jpag.2019.05.002
Bingham JM, Black M, Anderson EJ, Li Y, Toselli N, et al. Impact of
telehealth interventions on medication adherence for patients
with type 2 diabetes, hypertension, and/or dyslipidemia: a systematic review. Ann Pharmacother. 2021;55(5):637-49. doi:
1177/1060028020950726
Thakkar J, Kurup R, Laba TL, Santo K, Thiagalingam A, et al.
Mobile telephone text messaging for medication adherence
in chronic disease: a meta-analysis. JAMA Intern Med.
;176(3):340-9. doi: 10.1001/jamainternmed.2015.7667
Park HS, Ratner ES, Lucarelli L, Polizzi S, Higgins SA, et al.
Predictors of vaginal stenosis after intravaginal high-dose-rate
brachytherapy for endometrial carcinoma. Brachytherapy.
;14(4):464-70. doi: 10.1016/j.brachy.2015.03.00117. Stahl JM,
Qian JM, Tien CJ, Carlson DJ, Chen Z, et al. Extended duration
of dilator use beyond 1 year may reduce vaginal stenosis after
intravaginal high-dose-rate brachytherapy. Support Care
Cancer. 2019;27(4):1425-33. doi: 10.1007/s00520-018-4441-5
Bakker RM, Vermeer WM, Creutzberg CL, Mens JWM, Nout RA,
et al. Qualitative accounts of patients’ determinants of vaginal
dilator use after pelvic radiotherapy. J Sex Med. 2015;12(3):764-
doi: 10.1111/jsm.12776
Hanlon A, Small W Jr, Strauss J, Lin LL, Hanisch L, et al. Dilator
use after vaginal brachytherapy for endometrial cancer: a
randomized feasibility and adherence study. Cancer Nurs.
;41(3):200-9. doi: 10.1097/NCC.0000000000000500
Friedman LC, Abdallah R, Schluchter M, Panneerselvam A,
Kunos CA. Adherence to vaginal dilation following high dose
rate brachytherapy for endometrial cancer. Int J Radiat Oncol
Biol Phys. 2011;80(3):751-7. doi: 10.1016/j.ijrobp.2010.02.058
Liu M, Juravic M, Mazza G, Krychman ML. Vaginal dilators: issues
and answers. Sex Med Rev. 2021;9(2):212-20. doi: 10.1016/j.
sxmr.2019.11.005
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